First hospital district commissioner candidate forum

Less than two months remain before Orcas residents vote whether or not to create a public hospital district. PHD commissioner candidates, set to be elected on the same day as the district, met their constituents for the first time at the Orcas Island Senior Center on Feb. 24.

More than 150 community members gathered into the meeting hall at 10 a.m. on a Saturday to find out more about the candidates running to represent them on the commission.

“That doesn’t mean that anybody currently interested in this is advocating that we build hospital on Orcas Island, it’s simply the name that’s in the state code. There currently are 58 hospital districts throughout the state of Washington, 14 of those do not have a hospital affiliated with them,” said forum moderator Lisa Byers. “The candidates are elected to five at-large seats. They are not elected by the five candidates that get the most votes. So pay attention to the positions today because candidates will be elected to those positions.”

Richard Fralick is running unopposed for hospital commissioner one; Pegi Groundwater is running unopposed for position two; Arthur Lange and Leif (mononymous) are running for position three; John Dann, Richard (R.J.) Myers, Diane Boteler and Bill Bangs are running for position four, while Steve Hulley formally rescinded his candidacy during the meeting; Patricia Miller is running unopposed for position five. Myers and Groundwater were unable to attend the forum due to previously scheduled conflicts and Dann was snowed in.

A subcommittee of the Coalition for Orcas Health Care curated nine questions to pose to the six candidates who were present at the forum. Before answering the questions, however, each candidate was given one minute to introduce themselves. They were asked to answer three questions: why are you running for commissioner; what do you believe Orcas residents want in a commissioner; and how did you arrive at this belief.

“Quite frankly I wish we were not in a position where we needed this, but after looking at the facts it seems quite clear in order for us to have a sustainable health care operation on this island it is necessary,” Fralick said. “The first board of governing commissioners will have an important role to perform. They will define the structure of the hospital district, they will determine the level of assistance to be provided to the existing practices, they will establish performance metrics, they will establish the fiduciary responsibility in setting the tax rate — the tax burden to us property owners, to ensure the quality of service that we have.”

Fralick said he was approached to run for the position because of his ability to make informed decisions and the belief that he would keep his word.

Since Groundwater was unable to attend, she sent a short statement that was read by COHC member Dale Heisinger.

“I want to make sure that we continue to have access to primary, urgent and after-hours care,” Heisinger read. “To have that kind of public hospital district, Orcas needs commissioners who are thoughtful, open, prudent, hardworking and creative. I believe I possess those qualities.”

Groundwater has both a legal and a business background which she said would make her a valuable asset to the commission. She said she recognizes that islanders want the PHD to do business openly, spend tax dollars carefully and to support both of the existing primary care providers impartially.

“I think Orcas needs a health care gladiator that knows the difference between self-serving paternalism and ethical advocacy,” said Leif. “I have arrived at this because of my experience of treatment and violation of public trust that requires redress of governance on Orcas to different – to affect public health and welfare. There are some things that are complicated and there are some things that are hard. This is mostly the latter, thus health care gladiator [is needed].”

Lange has been active in promoting the PHD, helping to lead previous Town Hall events hosted by the OCHC. Historically, Lange said, medical services have been subsidized with generous philanthropic donations.

“I really believe that the availability of primary and urgent care on Orcas is at risk. I believe that it’s a vital service — just like fire and EMS and sheriff. We don’t all use them to the same extent but we sure all want them there when we need them. And I think ours is at risk,” Lange said. “It’s not sustainable, it’s not predictable. We need to have a better solution.”

Boteler introduced herself as the only candidate for any position in the committee that has personal experience practicing as a primary care provider. She has served as a physician, medical director and medical controller for EMS.

“What we’re voting on is a hospital district, but what it’s really about is support for clinics: to provide primary care and other services like 24/7 urgent care for our community,” Boteler said. “This experience has motivated me to run for commissioner and shown me that what the people of Orcas need and want is personalized, excellent primary care and urgent care reliably available when needed.”

Bangs noted his newness to being a fulltime islander has made him the perfect candidate because he’s impartial and objective.

“I firmly believe the PHD is absolutely necessary for the sustainment of medical care on Orcas Island,” Bangs said. “I’ve been paying attention, I’ve been listening.”

Heisinger also read a short introduction about Dann, who was unable to make it to the forum because the previous days’ snow had stranded him in his driveway. According to the statement, Dann said he believes that funds should be limited to two or three medical service providers on the island and that he can provide helpful medical experience to the committee.

The final candidate to introduce themselves was Miller.

“A PHD is our most realistic, longtime solution,” Miller said. “I will leverage my financially conservative approach coupled with my extensive financial operational management experience to implement a system that delivers the essential health care services in an efficient manner.”

The candidates then answered the questions from COHC and the audience. For more information about the candidates, visit

Candidates had two minutes to answer the following questions.

Question 1: How do you see the hospital district and the fire district working together to meet the health care needs of the island?

Miller: “One of the first things I think the commissioners need to do is to work with the EMTs and the fire department to clearly articulate to the community who they should contact for which services.” Miller said the commissioners will need to work with EMTs and practitioners to figure out what services each organization is best suited to provide.

Fralick said he believes it’s important that the liaison between the groups be established and clarified. “There’s a lot of confusion in the community as to who to call and what to do. … One of the roles of the commissioners is going to be to clearly define what we mean by urgent care and what additional resources we can provide to that service to make it viable for our community. … I don’t think that we’re really, as a board of commissioners … going to be dealing much with that other than clearly defining the rules between the two groups.”

Question 2: What would be your prefered configuration for the delivery of health care services on the island, and what is the role of the hospital district in achieving that model?

Leif: “I really believe that the role of the commission is to promote collaboration, professional collaboration on this island. … The solution is not given, that we have a lot of really good pieces that need to get a whole lot better at working together. … It’s up to the pieces to decide what that configuration will be. … I think that right now what we should do is make sure that everyone stays afloat.”

Lange: “Ideally we would not have redundant overhead expenses. That’s the fundamental problem that I think exists in the present circumstance. … But the present circumstance also is what it is, and in terms of fairness, I think we need to ensure that all the providers have access to health care of their choice – if the entities are the providers. The commissioners don’t really decide these things. Ideally, I would love to see a single entity, however that is structured in our community, under what umbrella – a single entity that reduced the cost of delivery and most importantly that the members of our community have choices about who our providers would be.”

Question 3: What in your background and experience might lead you to believe that you can be fair and impartial in dividing funds between the providers?

Boteler: “I guess my whole career has been spent basically listening to people – that’s what primary care physicians do, listen to people tell their stories, and help them to navigate their health care.”

Part of that is to not be judgemental, Boteler said.

“I think that’s where we as an island are with our health care. … People need choices on where they get their health care – it’s about what’s right for taxpayer and voters. … I think that’s the important thing – to listen to what people express they want and also balancing the cost of it all and thinking best how to spend the money.”

Bangs: Bangs says he is a relatively new, full-time resident who doesn’t know the providers, so he says he can be objective. He worked as a systems engineer his entire career.

“Obviously what we’re doing as commissioners is we’re buying services. We want to make sure that those service provide fair value to the community.” Reviewing proposals from both providers, Bangs said, the committee would be identifying how to get both providers to stay on the islan.

Question 4: What are your thoughts about the role of the hospital district in influencing the type of medical services that are offered on the island?

The hospital district has an important role, said Fralick, because they’ll be distributing the funds.

“So it’s very important for the commissioners to look hard at the practices, see what services are being provided, and what the cost of those services are … make decisions based upon that … and using the leverage of the funding to make sure that appropriate metrics are in place to measure the quality of care that is being delivered. … It is very important, as a board of commissioners, that we are not in the position – and understand our role to be one of setting policy – not micromanaging the clinic. … It’s not up to us as sitting commissioners to determine exact services or to get ourselves involved in that part of the equation. We should be setting policy, and, through the use of a superintendent that we will have at the district, making sure the policies we set, leveraged by the control of the finances, be delivered in a fashion that we think is appropriate.”

Miller: “I kind of view this in two phases. I think initially the commissioners will need to work with the existing clinics to fund the basic services that we have today. Just to stop the bleeding, I guess is the best way I can think of it to say. But then, one of the important responsibilities of the commissioners is to conduct a needs assessment … identifying what the greatest needs are and prioritize. What services does the community need? And how can we fill those. Robust community input. … I know there’s issues with blood draws and the ability to get simple blood draws, there’s the urgent and after-hours care. There’s a whole list of services that no one of us needs all of, but many of us may need. … [the] role is to look at what additional services providers could provide and what’s the most efficient model to deliver those services.”

Question 5: What skills would you use in order to resolve a disagreement in order for the commissioners to make a decision? You may wish to use examples from the past.

Lange: “Great question, not easy to answer.” Lange said he spent 35 years as a management consultant, working with people on team building and conflict resolution. “I was trained as a psychologist, but I’m not a touchy feely psychologist – no offence to anyone who might have a preference for that. But, I say that because my training was in skills: in cognitive skills and behavioral skills for effective – I wrote three books on effective communication. I think I know something about that type of resolution process. And I think that’s one of the skill sets I could bring to the commissioners and to the negotiation process. Both with the members of the community and with the recipients of the services.”

Leif: “I think conflicts are very important but that it’s having some sort of basic agreed-upon ground rules for getting through it and identifying what people’s priorities are and working with the things that need change.” Leif said he thinks Orcas has been “duking” things out in the back rooms for a long time. He said it has put islanders in an untenable position and that the “board of governors” must set a good example. “I think that having a bunch of professionals doing things in a respectful way comes up with real solutions is a pretty incredible opportunity. … Personally, I hope that I win because I want to have Art as my backup and mentor.”

Question 6: How would you evaluate or measure for the effectiveness of clinics and practices receiving funds from the hospital district in how it serves Orcas Island residents?

Bangs: One thing that Bangs believes that the commission can do is to require practices to provide satisfaction surveys which would be available to the commission and public to view. He also said that the PHD itself should have, on its website, a complaint and suggestion management system; and be keeping a scorecard on a regular basis of medical performance, patient experience and financial performance, he said. He added that the commission should be reviewing the clinics’ financial performance, ideally on quarterly basis. “Making sure they hold up their end of the bargain that they made with the PHD. … We don’t know today if in two years UW is really committed to us. We’ll know that they’re committed to us when we see how they perform. And I hope they perform – we all want that. Many of us want that.”

Boteler: “I think that patient satisfaction scores are important. Although I think the first step in patient satisfaction is response to the clinic.” Boteler said that in her professional experience, the clinics for which she’s worked never heard the actual complaints from people. “I don’t see the commission being the first source for patient complaints or concerns about a clinic. That should be for the clinics themselves to respond to.” Boteler said that the clinics should keep record of complaints, and that should be included in quality reporting. Other quality aspects, she added, include urgent-need accessibility, ease of entry and response, and that quarterly reporting is necessary. “I think the UW is a new entity here, and I think it’s a learning experience for them – it certainly seems like – in trying to orient themselves to a rural island, and I think that Dr. Shinstrom has been here for a really long time and understands the needs of a rural island.” Boteler said the commission would be comparing both clinics and looking at UW’s desire to learn with and work with the commission to fit the public’s need will be an ongoing issue.

Question 7: What is the role of the hospital district in addressing patient satisfaction with a practice that is funded by the district?

Miller: “The public hospital district, I view, is a public overseer or an overseer of our health care systems. So I don’t believe it’s the commissioners’ direct responsibility to be involved in individual patient-specific issues. … I believe that complaints and concerns should first be articulated to the clinic, because it’s important to … make sure they’re aware of the issues and have an opportunity to resolve it. … [The] superintendent has [the] responsibility of day-to-day interaction with clinics, instilling performance measures to gauge clinic performance, patient access and quality.”

Fralick: “It’s very important to realize that from day one, [the] public hospital district has no contractual responsibilities with any of the practices. … One of the early roles will be to define what the rules of practices [ are] nd put in place contracts … established measures – quality of service guaranteed – then up to commissioners and superintendent to make sure those measures are put in place and quantified. … So establishing [an] appropriate contract is going to be one of the early and important things that we as commissioners are going to have to do.”

Question 8: What are your thoughts on supporting other health care services that are not currently available at the two existing clinics?

Leif: “I think there’s a lot of things that Orcas can do for itself. I don’t think we have any idea what they are yet, though. … Coming out with a list is counterproductive. … I think there are many undiscovered strengths. … The advantage that rural communities have is that they have sparse resources that are highly networked, and we need to make use of that … network including urban-rural settings – networking with urban settings in a controlled way … so that we get what we want.”

Lange: “Right up front, the primary issue is to make sure that we are ensuring access to primary and urgent care, including after-hours care. … There are services within that that could be improved or increased. … Beyond that, frankly, I have some concerns. … What do you want and what are you willing to pay for it? … I don’t want to just do things for the sake of doing them. I want to make sure that people want them and that they’re willing to pay for them.”

Question 9: What measures will you take to ensure fair and equitable distribution of the funds between practices or providers on the island?

Boteler: “We have, currently, two providers, but the commission itself is really starting from scratch, … looking in a detailed way at the requests what money they want and how they’re justifying that money. Then looking at practice numbers and what portion of the community they’re serving and make sure the request match[es] those numbers.”

Bangs: “I was reminded that fair is not necessarily equal. … Turns out what is fair, in a fair-market value for example – willing seller, willing buyer – is what people agree to. … What’s fair to you as a taxpayer, in buying or subsidizing services from the provider. … When providers agree, you have a bargain, and that’s going to be fair. You have to look for the value for different services being provided. It’s going to be an individual case-by-case basis. … How do you make sure that the community is getting the value they need for the price they’re paying and that the providers feel that, indeed, they’re being treated in a way that makes them want to stay here on the island.”